The Lancet Countdown 2022 Climate Change and Health Report (LCCCHR) and the IPCC Synthesis Report of the Sixth Assessment Report are scientifically unsound and utterly political. They feed into the framework of the UN Paris Climate Deal Negotiations’ alarmistic, hyperbolic, misleading and even deceitful information about climate change and health. The LCCCHR unwittingly exposes the devastating public health effects of the UN’s current Sustainable Development Goals (SDG6), which crucially omit hygiene as a basic aim. Conservation ideals written out in the UN sustainable development classic ‘Our Common Future’ in 1987 started the process which derailed hygienic principles and environmental health policies from the centre of the development agenda, even though they had produced a public health miracle in today’s affluent countries. Affluent countries still benefit from the fruits of this agenda, which started in the 19th century. Western elites now deny the Global South the benefits of hygienic principles and good environmental health due to misguided green ideological beliefs – a cruel form of eco-imperialism. The deceitful, hyperbolically alarmistic and misleading LCCCHR was pivotal in promoting an alarmistic declaration on climate change and health adopted by over 120 countries at COP28 in Dubai.
The 2022 Lancet Countdown Climate Change and Health Report (LCCCHR) states that in the area of “climate change and food insecurity”, “diarrhoeal diseases are the leading cause of malnutrition in children younger than five years, while other infections can severely affect nutrient absorption and utilisation” – a statement that the World Health Organisation endorses. The origins of this idea came from the famous 1968 WHO monograph written by Harvard nutritionists.
LCCCHR fails to mention that this form of malnutrition is called stunting, which is a permanent condition. It develops if child has experienced sufficient number of diarrhoeal and other infectious disease episodes before his or her first birthday. Stunting is also intergenerational in nature. Accordingly, the LCCCHR authors confuse hunger and undernutrition and falsely claim that “food insecurity is increasing globally, with 720-811 million people hungry in 2020”. The FAO report LCCCHR is referring to defines “hunger in the world as, as measured using the prevalence of undernourishment (PoU)”. Thus, as stunting is a permanent condition and intergenerational in nature, the most important determinant of “hunger” in the Global South is lack of hygiene conditions according to WHO, not lack of food.
In the World Bank we came to the same conclusion in our peer-reviewed report published in 2008, based on an extensive review of cohort studies that showed that infections play a critical role in the development of stunting. We tried with this report to revitalise hygienic principles to the centre of the global development agenda, because environmental health policies and legislation administered across multiple sectors – with hygienic principles and infection control in its core – helped to eradicate undernutrition from the OECD countries over the period starting from 1860s to around the 1960s. Thanks to these policies we became one head taller and smarter in the developed world. OECD countries are still enjoying the full benefits of these policies, because it is unthinkable to abolish legislation and institutions which guarantee hygienic conditions and high environmental health standards in rich countries.
Towards the end of the 19th century two sanitary officials, one in Massachussetts State Board (H.F. Mills) and the other in Hamburg (J.J. Reincke), scrutinised death rates in their respective areas. They both independently of each other discovered that clean water supplies and effective sewerage systems in urban areas brought down child deaths more than expected. For every prevented diarrhoeal death there were two to four additional prevented deaths from inter alia respiratory infections. The Mills-Reincke phenomenon was widely discussed in the 1920s and 1930s among public health professionals but was afterwards forgotten. Yet we were correct in our World Bank report to propose that this enigmatic phenomenon can be explained with improvements in hygienic conditions, as the WHO has also implied. As undernutrition is an acquired immunodeficiency caused by infections, this leads to increased mortality from, for example, measles. This explains, for instance, why measles mortality came significantly down in affluent countries well before mass vaccinations began.
The classic sustainable development report ‘Our Common Future‘ from 1987 developed by the World Commission on Environment and Development set out the future sustainable development goals of the United Nations in embryonic form. The Chairman of the World Commission was Norway’s Prime Minister (Labour Party) Gro Harlem Brundtland (MD, MPH). In addition to being a physician trained in Norway, she also holds a Masters degree in public health from Harvard University. Brundtland later became the Director General of the World Health Organisation (WHO), with unfortunate consequences due to her conservationist ideals.
According to renowned urban development researcher David Satterthwaite, Brundtland made an unfortunate decision to omit the ‘Brown Agenda’ from ‘Our Common Future’. Brown Agenda promotes crucial infrastructural urban development such as the provision of fresh water supplies and the installation of sewerage systems i.e., the build-up of infrastructure that protects health. ‘Our Common Future’, with its core demand that world must reduce energy consumption by 50%, helped to mainstream global environmental conservation policies and steer the global development agenda, with adverse effects on investment choices. African countries would need investments in coal fired power plants, which are needed to support municipal water supply and sewerage systems and to diminish now rapid deforestation. Poor countries are often unable to raise capital due to lack of credit history on their own and need bi- and multilateral assistance from rich countries.
Thus, it is not a coincidence that LCCCHR does not mention hygienic principles and the need to revitalise environmental health practices in the development agenda. Letter H was dropped from the formerly holy trinity of water, sanitation and hygiene (WSH), which historically has its roots in godliness. The United Nations’ Sustainable Development Goal 6 (SDG6) mentions only water and sanitation, because H needs water in quantity (around 200-250 litres per day per person) and electricity provisions to communities to pump clean water in and wastewater out from households. Conservationists intentionally do not allow poor people in the Global South to be blessed with the holy WSH trinity, but are unable – even if they very much wish – to take away WSH trinity from us ordinary people in rich countries. The holy WSH trinity was in the centre of the development agenda of the United Nations until the early 1990s.
I have previously described in detail the bitter scientific battle around the origins of childhood nutrition between ‘infectionists’ and neo-Malthusian ‘food securityists’ and how ineffective nutritional interventions and programmes finally replaced environmental health activities in the UN institutions starting from the early 1990s. This was based on just one small observational study from Bangladesh. Ultimately, the decision to remove environmental health and hygienic principles from the development agenda was simply an ideological choice promoted by conservationists and their mighty neo-Malthusian allies.
LCCCHR does not mention the Bradley classification of water-related diseases, of which water-washable diarrhoeal diseases are dominant (around 75-80 %) in unhygienic conditions and LCCCHR only mentions one category of water-related diseases i.e., waterborne diseases. According to the authors’ view, transmission of waterborne diseases is increasing due to climate change. This tells us vividly that the authors are unaware of the significance of hygienic principles. However, they are not the only ones, as even among health professionals in the developed world there is a widely held view that drinking water is the sole vehicle transmitting diarrhoeal diseases in developing countries. This bias allows Western do-gooders to provide the poor child with various development projects to supply a glass of clean drinking water and perhaps opportunities to wash his or her hands but nothing more. I call this belief a clean drinking water bias. I speculate that this bias owes to the fact that most large diarrhoeal outbreaks in highly developed countries with high hygienic standards tend to be waterborne. In unhygienic conditions, however, 24/7 hyper-endemic transmission of diarrhoeal diseases dominates and result from the inability to prevent infections including diarrhoeal infections by washing in a myriad different ways, which I have discussed extensively.
Deceptive LCCCHR
The current ‘scientific consensus’ of the health effects of climate change is buried on page 1,046 of the Sixth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC AR6):
An excess of 250,000 deaths per year by 2050 attributable to climate change is projected due to heat, undernutrition, malaria and diarrhoeal disease, with more than half of this excess mortality projected for Africa (compared to a 1961-1991 baseline period for a mid-range emissions scenario) (high confidence).
Every year there are over 50 million deaths around the world. LCCCHR does not mention this figure.
The current hype of the devastating health effects of climate change is based on the LCCCHR and the Synthesis Report of the IPCC AR6. To give further credibility to these ‘scientific’ reports, mainstream media reported last summer on issues like the ‘scorched earth’ and shocking public health effects of heat waves. Both LCCCHR and the Synthesis Report of the IPCC AR6 do not provide any new numerical estimates of the health effects of climate change but instead use colorful language to predict doom and gloom if Net Zero policies are not taken seriously. The lead authors of the LCCCHR in their latest commentary even use extreme language like this:
The threat is now to our very survival and to that of the ecosystem upon which we depend. Grave impacts of climate change are already with us and could worsen catastrophically within decades.
Between 1955 and the end of 2021, greenhouse gases (GHG) have trapped the energy equivalent of 374 zettajoules of heat in our oceans and atmosphere, the energy equivalent of 6.23 billion Hiroshima bombs.
LCCCHR gives the impression (in its figure four) that malaria is a growing problem due to climate change, especially in the Global South, by showing that since 1950 especially the “average number of months suitable for malaria transmission” has increased by 30%. However, the authors did not inform their readers that malaria mortality has dropped globally since 1950 by 75-88%.
For instance, these misleading statements are found in the LCCCHR:
Access to clean energy and technologies improves health, especially for women and children; low-carbon electrification, walking, cycling and public transport enhance air quality, improve health, employment opportunities and deliver equity. …
Accelerated decarbonisation would not only prevent the most catastrophic health impacts of accelerated heating, but, if designed to maximise health benefits, could also save millions of lives with healthier diets, more active lifestyles and improved air quality. …
Phasing out coal is particularly urgent because of its high greenhouse gas emissions and air pollution intensity.
In real life there are no practical clean energy solutions proposed by the ideologues to prevent the horrendous indoor air problem in many poor households of the Global South. Instead, as I have reported, the only way to climb the energy ladder in order to achieve clean indoor air is to rely on Liquefied Petroleum Gas (LPG). This feasible technology is rapidly spreading to South Asia and Sub-Saharan Africa. The energy ladder concept was abolished in order to strategically steer discussions on energy policies in the development agenda similar to the effect of abolishing H from the WSH holy trinity for political reasons.
LCCCHR does not mention that it is not the industry, power production and traffic in megacities of the Global South that are polluting ambient air, but rather residential heating and cooking is the root cause of high levels of particulate matter in households and in ambient air in these cities. Thus, the implication that coal is to blame is misleading, since electricity and heat are produced in power stations with effective scrubbers. In Helsinki we had two extremely efficient coal plants, which were producing simultaneously electricity and heat, until green ideologues managed to close them (one is still running until 2025). Helsinki has among the cleanest ambient air quality of any metropolitan area in the globe. These efficient coal plants were granted a United Nations environment award for their cleanliness in 1991 among many other environmental awards. The closure of the first of these plants might jeopardise heat security of the population in Helsinki this winter if cold spells hit Helsinki in January and February.
One should also note that London got rid of the deadly smog of the 1950s primarily via the Clean Air Act of 1956, which banned use of the most polluting household fuels (e.g. the dirtiest coal) and permitted only smokeless fuel in cities. It also led to increasing the height of some industrial chimneys and built new power stations away from cities, so that the pollution was dispersed more widely.
One core policy statement or recommendation of the LCCCHR is that by discontinuing eating red meat and drinking milk, public health would miraculously improve across the globe. Alternative forms of proteins promoted by these ideologues include lab-grown hamburgers, fermented fungi patties and insect-based protein shakes. I do not want to eat these foods.
Health and adaptation issues are now high on the global agenda thanks to the Lancet Countdown 2022 Climate Change and Health Report and the Synthesis Report of the Sixth Assessment Report of the Intergovernmental Panel on Climate. During the 28th Conference of Parties (COP28) in the United Nations Framework Convention on Climate Change (UNFCCC) in Dubai in November 2023, a political declaration was adopted by more than 120 Governments to increase efforts to find solutions to better adapt to a changing climate and to accelerate mitigation efforts based on “health co-benefits” mitigation. As IPCC assessments reports continuously stress, the best way to improve climate resilience is to bring back the Brown Agenda in the centre of the development agenda. The main reason why developed countries have better ‘climate resilience’ compared to the developing nations is their health protection infrastructure. The green do-gooders do not want the Global South to be blessed with this vital infrastructure, which resulted in a public health miracle in the now affluent countries.
Mikko Paunio is an Adjunct Professor in Epidemiology at the University of Helsinki, Department of Public Health.
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